Sitters

For sitters, the main objectives are to reduce the impact of tight joints keeping them flexible and to prevent curving of the spine (scoliosis), as well as maintaining a range of movement, which will help increase independence when carrying out day-to-day activities. A PT or OT should give guidance and training on how to achieve these aims using the following techniques:

Orthoses are external devices which support the arms, legs or spine to prevent or assist movement to achieve activities such as standing and supported walking. They include:

• Braces – which are recommended to support and stabilise the spine and braces to help with arm movement. For these to be effective, they have to be used for a minimum of five times per week
• Splints and braces – which can be used to keep joints in certain positions. To be effective, they should be worn for 60 minutes or, if appropriate, overnight.
• Neck support – which may be helpful when travelling.
• Supported standing – which stretches the legs, promotes a better posture, increases bone density, blood circulation and eases constipation. This should be for up to 60 minutes for a minimum of three to five times a week but five to seven times a week is best and recommended.

Exercises aimed at muscles that are ‘tight’ can be done with assistance and may be helped by using splints, standing frames and orthoses that help with position.

It’s important to be consistent in stretching. Combining effective stretches with splints and standing exercise is crucial. The routine should be adapted individually by a PT or OT. To be effective, stretching is recommended more than five to seven times per week.

All sitters should have a powered wheelchair with custom seating systems that meet their individual needs. Children usually have the cognitive and physical capabilities to use a powered wheelchair before they reach two years old so it is beneficial to carry out an assessment before the age of two.

Those who are stronger may prefer a lightweight manual wheelchair or perhaps one with power-assisted wheels which could enable greater independence.

Exercise should be encouraged for its many benefits such as maintaining and improving strength, flexibility, endurance and balance. It may also improve participation in school, college, work, leisure and social activities. Exercises should be performed in different ways; this can include exercise which involves lifting increasing weight (resistance training), swimming, physiotherapy that involves horse riding (hippotherapy), and wheelchair sports which are all enjoyable ways to exercise. A PT can advise on these.

As with non-sitters, different techniques and aids can be used to help maintain breathing and reduce secretions (see Section, Breathing (Respiratory and Pulmonary Care)). This is particularly important during any episodes of illness and before surgery.